Research Article
Volume 16 Issue 6 - 2021
Effect of Weight Loss on Pro-inflammatory Cytokines Post Sleeve Gastrectomy among Obese Children and Adolescents
Alanoud Aladel1*, Adel A Alhamdan1, F Khan1, Asim A Siddiqui1 and Aayed Alqahtani2
1Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
2Department of Biostatistics, Obesity Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
*Corresponding Author: Alanoud Aladel, Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
Received: March 18, 2021; Published: May 28, 2021


Introduction: Low-grade inflammation is a common occurrence in obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In obesity, increased levels of interleukins and other inflammatory cytokines in the circulation may partly reflect a spillover from the adipose tissue.

Methodology: A prospective study was carried out to assess the levels of pro-inflammatory factors (TNF-α, IL-1β, and IL-6), dietary intake, fasting blood glucose and lipid profile before and 6 months after sleeve gastrectomy (SG), among 21 morbidly obese children and adolescents aged ≤ 18 years.

Results: Subjects achieved significant decrease in all anthropometric measurements and sleep apnea 6 months after SG. A significant increase in high density lipoprotein (HDL) and a significant decrease in fasting glucose (FG) levels and IL-1β levels was observed 6 months post-surgery (p ≤ 0.05). The reductions in body mass index (BMI), hip circumference and triglyceride (TG) levels significantly correlated with IL-6 concentrations and the reduction in hip circumference and mid arm circumference correlated significantly with IL-1β levels post-surgery. Linear regression showed the role of BMI and energy intake to predict the decreased level of IL-1β after surgery.

Conclusion: Sleeve gastrectomy represents a safe method for downregulating the inflammatory state that could lead to CVD and insulin resistance (IR) in obese children and adolescents. The significant decrease in IL-1β, increase in HDL and resolution of sleep apnea after SG can reduce CVD risk factors among morbidly obese children and adolescent, whereas the significant decrease in FG can reduce IR risk factors.


Keywords: Inflammation; Sleeve Gastrectomy; Cytokines; Obesity


  1. Greenberg AS and Obin MS. “Obesity and the role of adipose tissue in inflammation and metabolism”. The American Journal of Clinical Nutrition 2 (2006): 461S-465S.
  2. World Health Organization. Obesity and overweight. Ref Type: Generic (2011).
  3. Raj M and Kumar RK. “Obesity in children and adolescents”. Indian Journal of Medical Research 132 (2010): 598-607.
  4. Sacheck J. “Pediatric obesity: an inflammatory condition?” Journal of Parenteral and Enteral Nutrition 6 (2008): 633-637.
  5. Al-Muammar MN and Khan F. “Obesity: the preventive role of the pomegranate (Punica granatum)”. Nutrition6 (2012): 595-604.
  6. Kathryn E and Wellen Hotamisligil GS. “Obesity-induced inflammatory changes in adipose tissue”. American Society for Clinical Investigation 12 (2003): 1785-1788.
  7. Bastard JP., et al. “Recent advances in the relationship between obesity, inflammation, and insulin resistance”. European Cytokine Network 1 (2006): 4-12.
  8. Fain JN. “Release of interleukins and other inflammatory cytokines by human adipose tissue is enhanced in obesity and primarily due to the nonfat cells”. Vitamins and Hormones 74 (2006): 443-477.
  9. Moschen AR., et al. “Adipose and liver expression of interleukin (IL)-1 family members in morbid obesity and effects of weight loss”. Molecular Medicine 7-8 (2011): 840- 845.
  10. Gullestad L., et al. “Inflammatory Cytokines in Heart Failure: Mediators and Markers”. Cardiology1 (2012): 23-35.
  11. Graf S and Schumm-Draeger PM. “[Diabetes and rheumatism: is diabetes mellitus also an inflammatory disease?]”. Zeitschrift für Rheumatologie 9 (2011): 747-751.
  12. Bruun JM., et al. “Regulation of adiponectin by adipose tissue-derived cytokines: in vivo and in vitro investigations in humans”. The American Journal of Physiology-Endocrinology and Metabolism 3 (2003): E527-E533.
  13. Roth CL., et al. “Changes in adipose-derived inflammatory cytokines and chemokines after successful lifestyle intervention in obese children”. Metabolism4 (2011): 445-452.
  14. Taha D., et al. “The prevalence of metabolic syndrome and cardiovascular risk factors in a group of obese Saudi children and adolescents: a hospital-based study”. Annals of Saudi Medicine 5 (2009): 357-360.
  15. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report”. Circulation25 (2002): 3143-3421.
  16. Alberti KG and Zimmet PZ. “Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation”. Diabetic Medicine 7 (1998): 539-553.
  17. Benraouane F and Litwin SE. “Reductions in cardiovascular risk after bariatric surgery”. Current Opinion in Cardiology 6 (2011): 555-561.
  18. Jamoussi H., et al. “Metabolic syndrome in Tunisian obese children and adolescents”. La Tunisie Médicale 1 (2012): 36-40.
  19. l'Allemand-Jander D. “Clinical diagnosis of metabolic and cardiovascular risks in overweight children: early development of chronic diseases in the obese child”. International Journal of Obesity 2 S32-6 (2010): S32-S36.
  20. Sung RY., et al. “High prevalence of insulin resistance and metabolic syndrome in overweight/obese preadolescent Hong Kong Chinese children aged 9-12 years”. Diabetes Care 1 (2003): 250-251.
  21. Cook S., et al. “Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994”. Archives of Pediatrics and Adolescent Medicine 8 (2003): 821-827.
  22. Cruz ML., et al. “The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity”. The Journal of Clinical Endocrinology and Metabolism 1 (2004): 108-113.
  23. Amati L., et al. “Effects of a hypocaloric diet on obesity biomarkers: prevention of low-grade inflammation since childhood”. Current Pharmaceutical Design 7 (2010): 893-897.
  24. Medzhitov R. “Origin and physiological roles of inflammation”. Nature 7203 (2008): 428-435.
  25. Hotamisligil GS. “Inflammation and metabolic disorders”. Nature 7121 (2006): 860-867.
  26. , et al. “Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women”. Archives of Internal Medicine 164.10 (2004): 1066-1076.
  27. Hotamisligil GS., et al. “Tumor necrosis factor alpha inhibits signaling from the insulin receptor”. Proceedings of the National Academy of Sciences of the United States of America 11 (1994): 4854-4858.
  28. Stephens JM., et al. “Tumor necrosis factor-alpha-induced insulin resistance in 3T3-L1 adipocytes is accompanied by a loss of insulin receptor substrate-1 and GLUT4 expression without a loss of insulin receptor-mediated signal transduction”. Journal of Biological Chemistry 2 (1997): 971-976.
  29. Boura-Halfon S and Zick Y. “Phosphorylation of IRS proteins, insulin action, and insulin resistance”. The American Journal of Physiology-Endocrinology and Metabolism 4 (2009): E581-E591.
  30. Yuliana ND., et al. “Comprehensive review on herbal medicine for energy intake suppression”. Obesity Reviews 7 (2011): 499-514.
  31. Atkinson TJ. “Central and peripheral neuroendocrine peptides and signalling in appetite regulation: considerations for obesity pharmacotherapy”. Obesity Reviews 2 (2008): 108-120.
  32. Xanthakos SA. “Nutritional deficiencies in obesity and after bariatric surgery”. Pediatric Clinics of North America 5 (2009): 1105-1121.
  33. Nienhuijs SW., et al. “Evaluation of laparoscopic sleeve gastrectomy on weight loss and co- morbidity”. International Journal of Surgery 4 (2010): 302-304.
  34. Alqahtani A., et al. “Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study”. Surgical Endoscopy (2012).
  35. Kuczmarski RJ., et al. “CDC growth charts: United States”. Adviser Data - IAPD 314 (2000): 1- 27.
  36. Al-Disi D., et al. “Subjective sleep duration and quality influence diet composition and circulating adipocytokines and ghrelin levels in teen-age girls”. Endocrine Journal 10 (2010): 915-923.
  37. Al Nozha M., et al. “Evaluation of the Nutritional Status of the People of Saudi Arabia. Final Report”. Riyadh(KSA): King Abdul Aziz City for Science and Technology(KACST) (1997): 269-291.
  38. Blackburn GL. “Treatment approaches: food first for weight management and health”. Obesity Research 4 (2001): 223S-227S.
  39. Wang J., et al. “Comparisons of waist circumferences measured at 4 sites”. The American Journal of Clinical Nutrition 2 (2003): 379-384.
  40. Alqahtani AR., et al. “Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years”. Annals of Surgery 2 (2012): 266-273.
  41. Mahdy AK., et al. “Cardiovascular disease risk reduction by raising HDL cholesterol-current therapies and future opportunities”. British Journal of Pharmacology (2012): 10-5381.
  42. Benaiges D., et al. “Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile”. Obesity Surgery 8 (2012): 1268-1275.
  43. Pardina E., et al. “Only C-reactive protein, but not TNF-alpha or IL6, reflects the improvement in inflammation after bariatric surgery”. Obesity Surgery 1 (2012): 131-139.
  44. Reinehr T., et al. “High-sensitive C- reactive protein, tumor necrosis factor alpha, and cardiovascular risk factors before and after weight loss in obese children”. Metabolism9 (2005): 1155-1161.
  45. Giugliano G., et al. “Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women”. British Journal of Plastic Surgery 3 (2004): 190-194.
  46. Illan-Gomez F., et al. “Obesity and inflammation: change in adiponectin, C-reactive protein, tumour necrosis factor-alpha and interleukin-6 after bariatric surgery”. Obesity Surgery 6 (2012): 950-955.
  47. Ben OO., et al. “Effect of individualized exercise training combined with diet restriction on inflammatory markers and IGF-1/IGFBP-3 in obese children”. Annals of Nutrition and Metabolism 4 (2010): 260-266.
  48. Belisle SE., et al. “Polymorphisms at cytokine genes may determine the effect of vitamin E on cytokine production in the elderly”. Journal of Nutrition 10 (2009): 1855-1860.
  49. Zimmet P., et al. “The metabolic syndrome in children and adolescents”. Lancet9579 (2007): 2059-2061.
  50. Despres JP and Lemieux I. “Abdominal obesity and metabolic syndrome”. Nature7121 (2006): 881-887.
  51. Esposito K., et al. “Role of adipokines in the obesity-inflammation relationship: the effect of fat removal”. Plastic and Reconstructive Surgery 4 (2006): 1048-1057.
  52. Tam CS., et al. “Obesity and low-grade inflammation: a paediatric perspective”. Obesity Reviews 2 (2010): 118-126.
  53. Su WS., et al. “Waist-to-Hip Ratio, Cardiovascular Outcomes, and Death in Peritoneal Dialysis Patients”. International Journal of Nephrology (2010): 831243.
  54. Park HS., et al. “Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-alpha and IL-6”. Diabetes Research and Clinical Practice 1 (2005): 29-35.
  55. Heitmann BL., et al. “Hip circumference and cardiovascular morbidity and mortality in men and women”. Obesity Research 3 (2004): 482-487.
  56. Thalmann S and Meier CA. “Local adipose tissue depots as cardiovascular risk factors”. Cardiovascular Research 4 (2007): 690-701.
  57. Yudkin JS., et al. “C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue?” Arteriosclerosis, Thrombosis, and Vascular Biology 4 (1999): 972-978.
  58. Gallistl S., et al. “Changes in serum interleukin-6 concentrations in obese children and adolescents during a weight reduction program”. International Journal of Obesity and Related Metabolic Disorders 11 (2001): 1640-1643.
  59. Festa A., et al. “Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS)”. Circulation 1 (2000): 42-47.
Citation: Alanoud Aladel., et al. “Effect of Weight Loss on Pro-inflammatory Cytokines Post Sleeve Gastrectomy among Obese Children and Adolescents”. EC Nutrition 16.6 (2021): 23-35.

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